WAIKOLOA, Hawaii — Intravitreal injections may successfully help manage submacular hemorrhages, according to a speaker here.
“We know that submacular hemorrhages have a significant variability in their clinical course,” Mark W. Johnson, MD, said at Retina 2013. “But it does seem that poor prognostic factors include thick blood under the fovea and the presence of AMD. And we know that when an eye has both of these factors, the final visual outcome if you don’t treat these is rarely better than 20/200.”
Johnson said he believes there is no role for pneumatic devices in a thin hemorrhage.
“I think that we can say of the initial objectives for doing pneumatic displacement, one of those was to facilitate early diagnosis and treatment,” he said. “I think that is no longer relevant because we don’t really need early diagnosis and treatment of the neovascular process. We can simply start treating with anti-VEGF while the blood is in place.”
For a thin hemorrhage with suspected choroidal neovascular membrane, Johnson said anti-VEGF monotherapy works successfully; a moderate hemorrhage can be treated with anti-VEGF therapy plus gas bubble initially, followed by tissue plasminogen activator if necessary; and a thick hemorrhage can be treated with anti-VEGF preoperatively followed by surgery.
Disclosure: Johnson has no relevant financial disclosures.